A FIFTEENTH CENTURY MEDICAL MANUSCRIPT.

748 of these cases -it was found that the of recent date or that it had been recently writing tampered with. ’This is an interesting example of "base uses " being ’revealed by chemistry. ’’In regard to samples referred under the ’Sale of Food and Drugs Acts when the public analyst’s con6lusions’are*impugned, the results of the examination at’the Government laboratory differed from those -of the public analyst in, five cases out of 91 in respect of which certificates -were issued. This points to an efficiency of’the analytical service which must be considered satisfactory. ’We note that in spite of the conclusions of the Royal ’Commission on’Whisky and ’Potable Spirits samples are still examined by chemical analysis under the Tood and Drugs Acts. ’Thus, a sample of brandy was alleged to contain spiritother than that derived from -the grape. It was ’found by the Government chemist "to be deficient in the characteristic constituents of brandy to such an extent as to indicate the presence of a large proportion of neutral spirit."But the Royal Commissioners concluded "that the application of -the termbrandy’ in this country cannot be controlled by the nature of the apparatus or process used in the distillationqfthe spirit." ’The ’italicsare ours. The It would Government chemist clearly thinks differently. be a public advantage if the ’Excise authorities would cooperate with the Government chemists more actively than they do in regard to the question of the misdescription ot spirits. Altogether this report is a most interesting public document. It must be remembered that it has no reference to the general question of public food-supply, for a department, now controlled by the Local Government Board, issues reports from time to time of the utmost value to the public analytical services in this direction. and in

six

was

___

RARE CAUSES OF HÆMATEMESIS. UNDER the term vomito negro appendiculaire,a term calculated to upset the equanimity of the verbal purist, Dieulafoy has described a very rare complication of appendicitis—hasmatemesis. In the Aqtstralasian Medical Journal of June 28th Dr. R. B. Duncan has reported an example. A publican, aged 30 years, was attacked one evening with pains confined chiefly in the right lower quadrant of the abdoThese symptoms conmen and severe persistent vomiting. tinued until he was seen early next morning by his medical attendant, who administered a hypodermic injection of morphine and ordered hot fomentations. These measures gave considerable relief. Dr. Duncan saw the patient in the afternoon when he was complaining bitterly of the pain. The tongue was coated and dry at the edges, the pulse was 110, and the temperature was 102°F. The abdomen was uniformly distended and rigid. The rigidity was most marked in the right lower quadrant, which was exquisitely tender. Rectal examination was negative. Early on the following morning the abdomen was opened by the McBurney method. The appendix was so bound down by adhesions that the incision had to be enlarged. The appendix was kinked in two places. It was removed and the base was crushed and buried in the usual manner with a purse-string suture. V oilliting commenced before the influence of the ansesthetic had worn off, and continued during the whole of that day On the morning of the third and the following day. " assume a suspicious colour the vomit to day began and the stomach was washed out. For the rest of the day the patient felt much more comfortable. the succeeding night the vomiting was almost continuous, and the vomit assumed a coffee-ground appearance. The stomach was again washed out and unmistakable evidence of haemorrhage was obtained. At this time the general condition was _fairly good. Afterwards.the vomit

During

In addition to consisted chiefly of dark clotted blood. further washing out, various drugs were tried without avail. On the seventh day the patient vomited a huge, very black, and somewhat firm clot, became collapsed, and died. At this time the wound had -soundly healed, the bowels had acted well, and the abdomen was soft. A necropsy is not described. At the middle of ; the appendix was a stricture that obliterated its lumen, and distal to that was a bulging which contained a thimbleful of fluid fasces. A smear from this was stained and showed the colon bacilli in almost In his Manuel de Pathologie Interne" pure culture. Dieulafoy has described several -cases of hsematemesis complicating- appendicitis, due to minute erosions of vessels lying under the ,gastric mucosa. He thinks that when the appendix is strictured or closed in any part of its course the contained microbes become exceedingly virulent, giving rise to a general " toxi-infection," to which he attributes the erosions. Most of the cases were fatal. We may point out that this form of hsematemesis appears to be pathologically identical -with a condition which has received attention only in recent years-post-operative hsematemesis. However, the hsematemesis associated with appendicitis may A short time ago occur before as well as after operation. an important paper on Gastric and Intestinal Heemorrhages after Operations was read at the Royal Society of Medicine by Mr..Jonathan Hutchinson.1 He reported a number of cases from the records of the London Hospital showing that haemorrhage into the stomach and intestine, due to small ulcers or erosions, may develop after an operation, usually abdominal (many of the operations were for appendicitis). In 80 per cent. of the cases a severe septic infection with secondary anaemia was present before the operation. Similar lesions were found in certain cases of disease in which no operation was performed. Mr. Hutchinson held that a profound alteration in the blood, due in most cases to toxins of septic origin, was the chief factor in the pro. In our correspondence columns duction of the erosions. this week Mr. C. Gordon Watson has reported a case of hasmatemesis due to another comparatively unrecognised cause-thrombosis of the splenic vein. He also has suggested that some cases of post-operative basmatemesis may be of this nature. ____

A FIFTEENTH CENTURY MEDICAL MANUSCRIPT. ’IT appears that Monseigneur de Cleves and Monseigneur de Croy, representatives of Philippe-le-Bon, Duke of Burgundy, were taken ill during their stay in Mantua, and Francis Sforza, Duke of Milan, placed them in the care of his physician, Guido Parato, who, on the recovery of his distinguished patients, sent by them as a present to their master a manuscript entitled "Libellus de Sanitate Conservanda."" This the Duke placed in his library at Bruges and ordered a French translation to be made. ’This translation, which is now in the Bibliotheque Imperiale at St. Petersburg, has been made the subject of an interesting paper read to the Société Francaise d’Histoire de la Medecine by Dr. Wickersheimer. Although of no scientific importance, the manuscript appears to be an interesting specimen of fifteenth century calligraphy, and consists of 132 leaves of parchment, with illuminated initials, encadrements, and the arms of the Duke of Burgundy. It also has a fine miniature representing the physician Guido Parato kneeling before the Duke and presenting him with a book. But the work is not original. It is based on the Regimen Sanitatis " of Magnino de Milan, whose prescriptions were almost all copied textually by Parato. Many things were also borrowed from the Regimen Sanitatis " of Arnold de Villanova. Concerning these two writers, to 1

THE

LANCET, Dec. 17th, 1910, p. 1761.

749 whom Parata never once refers, although his- references-to ancient writers are conspicuous, medical historians have been at variance regarding their connexion one with the other. From a note in the Surgeon-General’s catalogue we read’: 411,t, is claimed by some- authorities that Magnino was a’ pseudonym under which Arnold de Nova Villa wrote ’Regimen Sanitatis.’ Others say he was a physician of 114ifan in the thirteenth century, and an extensive plagiarist from Arnold." And in the British Museum Catalogue- we Rnd a bibliographical note to the effect that the " Regimenof Magnino is really the work of Arnoldus, but with alterations, transpositions, and additions by Magnino. Concerning Magnino, little seems to be known, and the more important medical biographies, dictionaries, and histories contain no account of his life. His name is not to be found in the "Biographisches Lexikon: der Hervorragenden Aerzteor in the index to " Neuberger and Pagel’s"Geschichte der Medizin." Needless to say, the name of Guido Parato does not appear either. Whatever may have been the case in the work of Magnino, it is, evident that Parato looked upon plagiarism as no new sin, Dr. Wickersheimer thinks it is not probable that thismediocre compilation will ever meet with an editor: Nevertheless, unearthing early manuscript treatises of medicine and making their nature and contents known is one of the functions of any medico-historical society. Medical manuscripts of that period are not so numerous that the bibliographer and historian can afford to ignore them.

inspection had’ been’ used or that any direct. stability had recently or habitually been employed. The evidence of’ the deputy city engineer was to the effect that such a piece of wood might be-expected to remain in use without danger for 15 or even for 20’years, and that the gravelly and sa7ndy’natiire of’the ground’in which it was set had been relied upon to, minimise the decay which in fact had taken place. The jury, after a’ discussion with the coroner which emphasised their opinion that more care should

form’ of

tests of’its

have been taken, found a verdict’’that the deceased died fMm’ injuries to the neck and skull caused by a maypole swing at Chapel Field playground accidentally falling upon him whilst swinging thereon, the maypole being in a, defective condition! and that there has been neglect on the part of the corporation in not having the’pole properly tested." With, regard to the position of the Norwich corporation in the case of this particular accident it may be better toabsts,in.from comment because there is an obvious possibility that that body may be called upon to consider the question of civil. liability. to the chil’d’s parents. Upon the general question, however, of£ such. playgrounds as the one in. question, it may be pointed out that maypoles, or giant’s strides- as they are usually called, swings ; trapezes, climbing ladders, and horizontal and parallel bars offer an appreciable amount of: opportunity to children to injure themselves without such opportunity being increased by latent defects in the apparatus itself. In. gymnastic exercises where apparatus is used there is-usually the possibility of a. more or less, dangerous fall, and in thecase of swings, including the maypole or giant’s stride, there is- the additional and. more serious risk of one child? GYMNASTIC APPARATUS IN PUBLIC being injured by getting in the way of another. ThesePLAYGROUNDS. dangers, are increased when the appliances in: question’ are:’ AN accident which took place recently at Norwich in a used without any restriction by children of various ages- and public recreation ground known as the Chapel Field subject to no kind of discipline. Accompanied by a measure Gardens, and apparently maintained by the corporation, of adult supervision they may afford means’ of healthy should serve as a warning to public authorities, and indeed recreation, but the benefit obtainable from; them will always to all other bodies and persons, who provide playgrounds be increased in proportion to the amount of supervision and for children furnished with swings and other apparatus instruction in. their proper use that is provided with them. for their amusement. The facts of the case referred to were Without any such supervision the best- that can be said. of proved at the inquest held upon George Graver, a little boy them, perhaps, is that they will still tend, but less markedly, 10 years of age, who met with his death through the pole to cause boys and girls to exercise their muscles, and to of a " giant’s stride"snapping two or three inches below learn to use care and accuracy of movement, as well as con. the ground while he was amusing himself upon it. Several sideration for others in order to avoid causing injury or being other children had been using it with him, but a little’ hurt. The other matter, however, is outside the province of girl, also aged 10, who must be congratulated upon her childhood, and the young are- pretty sure to trust with- the intelligence, stated in the witness-box that she heard the confidence of youth appliances with which their elders pole crack, realised the danger, and with the others, except supply them. Fortunately, a little care on the part of’ those the deceased, desisted. She then called to Graver, telling elders will practically insure the stability of gymnastic him that the pole might fall, but he, boy-like, persisted apparatus such as that generally in use, when the users alone, with the result that when the shaft collapsed, which are children. Steel cores can be ;employed in wooden it did almost immediately, it descended directly upon him, articles likely to be submitted to intermittent strain or fracturing his skull. He was conveyed at once to the hos subjected to conditions likely to cause decay; and ropes pital in a motor-car which happened to be near, but was when used are generally more or less exposed to view; but found on his arrival to be already dead. The coroner’s jury it is not necessary to trust to the inherent strength of was naturally anxious to have particulars as to the condition the article nor to rely exclusively upon inspection. If’the of the pole and as to the amount of care taken to ascertain apparatus is meant for the use of a child or children it is its suitability for its purpose. It had been erected in 1902 not diffioult or dangerous for a man (or perhaps more than in a subsoil of gravel and sand, and recently (two years ago) one man) to apply to it a test of its strength considerably had been plated with iron near the ground to protect it from exceeding the normal strain, to which it will be subjected. the blows of the rings held by the children when swinging. It is not necessary to examine a pole under ground in On the ground round the foot there was asphalt sloping order to see to what extent moisture has caused it outwards and designed to prevent the accumulation of to rot, when it is easy to ascertain by using the strength water. The height of the pole was 18 feet above ground, and weight of adults intelligently whether it is sub. with 6 or 7 feet below ; its diameter was 10 inches at its stantially sound or dangerously weak. Education authovisible base, the portion below the surface being about rities have before now been sued in respect of school 10inches square. So recently as a fortnight before the playgrounds when the negligence alleged has consisted accident a man had ascended it. to grease’ the iron in an irregularity of the ground which, has, tripped a fittings at the top and had noticed nothing wrongy boy up and caused him to fall, so that they, as a rule; but- it was not found at the inquest that any other are probably watchful against danger. Those, however, who ____